equester's Information

Name (last, first): *

Employee ID: *

Requisition Date: *

Department: *

Phone: *

Fax:

Email: *

Vendor's Information
Suggested Vendor (if known):

Vendor ID:

Contact Name (last, first):

Address:

Phone:

Fax:

Email:

Ship To Information

Department:

Building Name:

Contact Name (last, first):

Address:

Room:

Phone:

Fax:

Email:

Order Details
Currency:

Delivery Date (norm 4-6 wks):

Term of Agreement: Start Date:

Term of Agreement: End Date:

select...

Electrical (CSA or approved equivalent):

Warranty:

Freight:

Special Instructions: Item #1Item #2Item #3Item #4Expense

select...

Schedule/Distribution(1)

Fund Type:

Other:
If Other Fund Type, please specify. If research fund, attach approval documentation

Speed Chart: *

Account: *

Fund:

Dept ID (Org):

Program:

Sub-Cls:

Budget Year:

Project/Grant:

Amount: Amount By % or $: $

(1) Name of Authorized FMS Signing Authority: *

(2) Name of Authorized FMS Signing Authority: *

Expense Schedule/Distribution(2)
select...

Fund Type:

Other:

Speed Chart:

Account:

Fund:

Dept ID (Org):

Program:

Sub-Cls:

Budget Year:

Project/Grant:

Amount: Amount By % or $: $

(1) Name of Authorized FMS Signing Authority:

(2) Name of Authorized FMS Signing Authority: Click the Download button to download the pre-filled PDF to your computer. Once you have obtained the necessary signatures on your form, email signed form to purchase.requisitions@ubc.ca. Keep original form for your records.